EXECUTIVE SUMMARY
A patient who underwent a colonoscopy says he inadvertently left his phone recording during the procedure after he taped postoperative instructions. He reported hearing staff making many inappropriate comments and filed suit.
• Have a policy on cell phones.
• Train employees about distractions in the OR and inappropriate comments about patients and staff. Encourage them to speak up.
• Implement a "sterile OR" in which there is no irrelevant communication during critical phases of surgery. Designate one staff person in the OR to address outside communication from persons or cell phones.
By Joy Daughtery Dickinson
A patient underwent a colonoscopy last year, during which he says he was mocked by staff members who said he had syphilis and discussed firing a gun up his rectum, according to Courthouse News Service.1 On the ride home with his wife, the patient determined that he had accidentally left on his phone after recording postoperative instructions, the news report said. They said they listened in disgust to the recording.
The patient claims that comments from the OR staff included "Oh — Oscar Mike Goss," which is a substitute for the expression OMG, and comments on the amount of anesthetic needed. The patient also claims comments were made about his being "a big wimp" and that another physician "would eat him for lunch." He says one staff members said that "after five minutes of talking to you in pre-op, I wanted to punch you in the face and man you up a little bit." Staff members also commented on the patient attending a college that was once a women’s college and speculated that the patient was gay, the patient claims.
A staff member also said the patient was a "retard" for looking at an IV placement that he earlier said makes him pass out, he claims. The patient says comments were made regarding an irritation on his penis, and that a medical assistant touched his penis during the procedure. The patient claims the doctors also talked about "misleading and avoiding" him after the procedure. One staff member said she would make a note in the medical record that the patient had hemorrhoids, even though he didn’t, the claim says.
The patient seeks $1 million in compensatory damages and $350,000 in punitive damages for defamation, infliction of emotional distress, and illegally disclosing his health records.
Comments made during a surgical procedure can be more than unprofessional or even libelous; they can be a distraction that causes safety issues which negatively impact the patient’s outcome, says sources interviewed by Same-Day Surgery.
"If there is a negative outcome, and others can argue or show that was due to lack of attention being paid to the procedure or the patient, it can have a liability impact by creating or increasing liability" says Stephen Trosty, JD, MHA, ARM, CPHRM, president of Risk Management Consulting in Haslett, MI, and a past president of the American Society for Healthcare Risk Management (ASHRM).
Trosty shares this example: At a medium-sized hospital in Ohio, there was talking and joking in the OR that distracted the anesthesiologist and surgeon, who missed monitoring the patient. The patient had a problem with the anesthesia and ended up in a permanent vegetative state. "This resulted in a horrific patient outcome and a very large judgment against the hospital and physician," Trosty says.
Michelle Feil, MSN, RN, senior patient safety analyst at the Pennsylvania Patient Safety Authority in Plymouth Meeting, PA, says, "When human beings are distracted from a primary task, one of two things will occur: He or she will have a delay in resuming the primary task, or they will commit an error."
A leading international researcher on distraction in healthcare says there have been multiple serious safety incidents in United Kingdom ORs in which distraction played a role, including a surgeon doing the wrong anastomosis in a colorectal case and one entirely forgetting to do part of a procedure. "Being distracted was one of many contributing factors in these cases," says Nick Sevdalis, PhD, senior lecturer in the Faculty of Medicine, Department of Surgery & Cancer, Imperial College London. "From what we know, I would say extraneous talking (i.e. discussions that have nothing to do with the patient on the table) tend to distract the surgeon and the wider OR team. This may be harmless in most cases, but on occasion reduced concentration and focus can reduce safety checks during cases and thus result in potential increase to risks to the patient."
The Pennsylvania Patient Safety Authority recently released a report that said distraction is a threat to patient safety in the OR.2 An analysis of reported events from January 2010 through May 2013 found 304 reports of OR events in which distractions and/or interruptions were contributing factors. "The types of events we are seeing most frequently reported to the Pennsylvania Patient Safety Authority that involve distraction in the OR are incorrect counts and specimen handling problems," Feil says. "But there have been reports of distractions contributing to serious events ranging from wrong-side surgery, to failure to notice a significant loss of evoked potential from a patient’s arm during spinal surgery, to transfusion of the wrong blood to the wrong patient."
And recorded cell phone conversations aren’t the only potential problem. Some surgical patients have reported being alert to everything being said and done in the OR but being paralyzed so they can’t move or respond, sources says. (For more on this topic, see "Media and lawsuits put spotlight on awareness in outpatient surgery," Same-Day Surgery, June 2007, p. 65.)
How to avoid OR distractions
To address OR distractions, consider these strategies:
• Have a policy on cell phones.
A member of the staff should remind all patients that cell phones must be turned off, Trosty says.
"This should occur when the patient arrives and is registered and again before the patients go into surgery," he says. "It should be verified before surgery."
Have a policy that no cell phones are allowed in the OR, and ensure that all cell phones are given to the person who is with the patient, Trosty says. "This can become part of the checklist that occurs prior to surgery," he says. "This provides several opportunities to state the policy and to help ensure that it is adhered to."
This policy also should apply to staff members, physicians, and vendors, says Mark Mayo, executive director of the ASC Association of Illinois and principal, Mark Mayo Health Care Consultants in Round Lake, IL. Mayo says, "What is more important: a call to your broker or checking your e-mails, or taking care of our patients? What if a transient change in the patient’s condition is recorded, but the anesthetist missed it because he/she was on the phone?"
• Examine where interruptions are coming from.
Determine what clinical staff outside the OR are interrupting and distracting the surgical team during procedures, Feil advises. She suggests you ask these questions: "Are these interruptions due to OR scheduling problems? Are they related to clinical concerns with other patients in the hospital?"
"Whatever can be done to limit clinically irrelevant communication with the OR team during procedures would improve patient safety," Feil says.
Considering channeling OR visitors to one OR team member, such as a senior nurse circulator, Sevdalis advises. "The circulator could filter the importance and urgency of a request, so that the rest of the team does not get unnecessarily distracted," he says. "The same applies to phones and pagers: They can be left outside the OR and handled by a team member so that they do not interrupt the team during a case."
• Train employees and discuss disciplinary repercussions.
Because it is nearly impossible to stop irrelevant talk in the OR, consider exercising discipline provided for in your policy, Trosty suggests.
"If this is done and people know you are serious and there will be consequences if does occur, it might increase chances for compliance and an end to discussions," he says.
Train staff about why it is important not to talk in the OR, explain what your policy says, and discuss what the results will be if the policy is violated, Trosty says. "This should be documented in each person’s employee or contract file," he says.
Emphasizes the quality-of-care issues and the potential impact, Trosty suggests. Discuss the risk issues, including the liability concerns, he says. "It should be stressed and included in training that certain types of discussions are never to occur, regardless of where the people might be," Trosty says. "It should be known and stressed and staff should be educated to the fact that there are specific topics and issues regarding not only patients but also other staff that are completely unacceptable."
Such training can help avoid comments such as the ones reported in the colonoscopy case, sources say. Regarding that case, Feil says, "This is inappropriate small talk taken to the extreme."
Such comments are not only distracting, but also demeaning and degrading to patients, she says. We owe it to our patients to treat them with the utmost respect and dignity, and to conduct ourselves professionally, focusing on the procedure at hand and avoiding all potential distraction," Feil says. "There is a sacred trust that should not be violated when patients have placed their very lives in our hands when undergoing anesthesia." (For more tips, see suggestion for mimicking a "sterile cockpit," see below, and advice from the TeamSTEPPS program, see at right.)
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Abbott R. Unconscious patient says doctors mocked him. Courthouse News Service. Accessed at http://www.courthousenews.com/2014/04/22/67225.htm.
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Feil M. Distractions in the operating room. Pennsylvania Patient Safety Authority. Accessed at http://bit.ly/SIdpOd.
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To access the free Pennsylvania Patient Safety Authority report "Distractions in the Operating Room," go to http://bit.ly/SIdpOd.
